Inner-city children of low socioeconomic status are at high risk for initiating tobacco use during adolescence and continuing its use throughout adulthood. The high utilization of acute-care services for non-emergent health problems by adolescents suggests that the emergency department (ED) offers a promising and innovative setting for the prevention of tobacco use. Furthermore, because adolescent patients seeking urgent care typically are accompanied by parents, an intervention delivered in the ED can reach child and parent simultaneously. The rationale for coincident child/parent intervention derives from the strong association of adolescent smoking with perceived parental leniency toward smoking. The K23 award will provide the time, resources, and mentorship for the Candidate to integrate her research interest in tobacco prevention with her clinical experience in emergency medicine. Her long-term goal is to develop tailored interventions that will help parents prevent tobacco initiation and use by their adolescent children. The research plan proposed for the Award period centers on the pilot testing, revision, implementation, and evaluation of a tobacco prevention strategy entitled Improving Parent/Adolescent Communication about Tobacco (IMPACT). The strategy was developed by the research team and is based on the Theory of Planned Behavior. The intervention consists of: culturally appropriate verbal and written messages about tobacco use that can be conveyed by parents to their adolescent children aged 11-14 years;a videotape that models effective parent-adolescent discussion of these messages, and;a survey instrument to test the effectiveness of the intervention. Focused interviews, quantitative evaluation, and expert review of IMPACT will result in revision of the materials, followed by evaluation of the effects of IMPACT using a six-month longitudinal, randomized design. The proposed research seeks to explore the effect of IMPACT on validated measures of adolescent intention and willingness to smoke, as well as potential mediators and moderators of the effect. Hypothesized mediators include adolescent knowledge of tobacco risk;adolescent perceptions of parental attitudes, social acceptance, and prevalence of tobacco use;and the self-efficacy of adolescents to avoid, and parents to prevent, use. Hypothesized moderators include adolescent race/ethnicity, adolescent gender, and parent smoking behavior. The career development plan proposed for the Award period incorporates coursework in advanced qualitative and quantitative methods, health behavior theory, adolescent addiction, as well as field observation of existing tobacco prevention programs. By the end of the Award period, the Candidate expects to submit an R01 grant application for a longitudinal study designed to assess the effect of IMPACT on adolescent experimentation, initiation, and ongoing use of tobacco.